This disclosure relates to the field of athletic and medical wraps in general and specifically to a tourniquet for use with major vascular trauma. A tourniquet is a constricting or compressing device used to control venous and arterial circulation to an extremity for a period of time. Pressure is applied circumferentially upon the skin and underlying tissues of a limb; this pressure is transferred to the walls of vessels, causing them to become temporarily occluded. It is generally used as a tool for a medical professional in applications such as phlebotomy or to stem the flow of traumatic bleeding, especially by military medics.
The ideal tourniquet is applied quickly and effectively and controls hemorrhage with minimal risk of tissue damage. Potential complications of tourniquets include ischemia, thrombosis and nerve injury and compartment syndrome. Problems related to putting the tourniquet in place include device malfunction, mal-positioning, inadequate bleeding control or excessive pressure leading to continued hemorrhage or ischemia and nerve palsy respectively. Taking into account that soldiers, under extreme stress, have to apply the tourniquet to their own body or that of a comrade, the tourniquet should be fast, simple, not confusing and reliable. Since control of bleeding often requires two tourniquets, they should be light weight and easily accessed from a pocket or pack. Since many wounds require pressure dressings, the tourniquet may serve as a quick and effective means of securing gauze and packing in a scenario where tape doesn't work.
Surgical tourniquets prevent blood flow to a limb and enable surgeons to work in a bloodless operating field. This allows surgical procedures to be performed with improved precision, safety and speed. Tourniquets are widely used in orthopedic and plastic surgery, as well as in intravenous regional anesthesia where they serve the additional function of preventing local anesthetic in the limb from entering general circulation. Emergency tourniquets are used in emergency bleeding control to prevent severe blood loss from limb trauma. Emergency tourniquets are generally used as a last resort, especially in civilian applications, for if blood flow below the application of an emergency tourniquet is stopped, it can irreversibly compromise the tissue, leading to eventual loss of the limb below the tourniquet. However, use of tourniquets is widespread in military applications, and have the potential to save lives. Analysis has shown that in cases of major limb trauma, there is no apparent link between tourniquet application and morbidity of the limb. In recent years there have been significant advancements in tourniquets. These advancements have vastly improved tourniquet safety. Limb occlusion pressure (LOP) is the minimum tourniquet pressure required to occlude blood flow to a specific patient's limb at a specific time and accounts for a patient's limb and vessel characteristics, and the type and fit of the cuff. LOP can be determined by gradually increasing tourniquet pressure until distal arterial pulses cease, as indicated by a device sensing blood flow, such as a Doppler stethoscope. Studies have shown that cuff pressure based on LOP measured immediately prior to surgery is generally lower than commonly used cuff pressures and is sufficient to maintain a satisfactory surgical field. Automatic tourniquet systems are capable of providing safety features that are not possible in older mechanical tourniquets. These systems can monitor the cuff inflation time as well as regulate the cuff pressure to a known pressure throughout the surgical procedure. Some microprocessor controlled tourniquets are capable of calculating the proper pressure to ensure complete blood occlusion in about 30 seconds. This assists the operating room staff in deciding what the tourniquet pressure should be set at on a per-patient basis. Studies have shown that tourniquet cuff pressure can be substantially reduced by using wide, contoured cuffs. A wider and contoured cuff has more contact with the limb's surface area so it disperses the cuffs force. This concept is emerging from the surgical field into the emergency field with wider emergency tourniquets.
The Combat Application Tourniquet (CAT) was developed by Composite Resources, Inc. and is used by the U.S. and British military to provide soldiers a small, effective tourniquet in field combat situations, and is also in use by NHS ambulance services, and some UK fire and rescue services. The unit utilizes a windlass with a locking mechanism and can be self-applied. The CAT has been adopted by military and emergency personnel around the world. The present conflicts in Iraq and Afghanistan have demonstrated the value of timely and judicious use of tourniquets in the battle field and in field medical facilities with regard to saving limbs as well as the survival of those who have been injured. The above disclosed Combat Application Tourniquet technology and know-how, although widely implemented, has significant and serious limitations, such as being too complex for a dazed person to quickly affix and too expensive to manufacture.